Docs Need To Inoculate Themselves Against Single-Payer

People rally in favor of single-payer healthcare for all Californians as the US Senate prepares to vote on the Senate GOP health care bill, outside the office of California Assembly Speaker Anthony Rendon, June 27, 2017 in South Gate, California. Rendon announced last week that Senate Bill SB 562 - the high-profile effort to establish a single-payer healthcare system in California - would be shelved, saying it was 'incomplete.' (Photo by Robyn Beck/AFP/Getty Images)

A majority of doctors now approve of government-run, single-payer health care, according to a new survey from Merritt Hawkins, a physician recruitment firm.

Doctors should be careful what they wish for. Single-payer could transform doctors from highly respected, independent professionals to order-taking, unionized government employees.

It's hard to understand why doctors, who have jealously guarded their right to practice medicine as they see fit, would willingly embrace a brand of healthcare reform that would lead to government micromanagement of their work.

Then again, physician morale has been declining for years. They're overwhelmed with paperwork, second-guessed by insurance bureaucrats, and overworked.

One study found that for every hour doctors spent with patients, they spent two hours on paperwork. Even when they were in the examination room, they spent just over half their time talking to or examining patients -- and 37 percent of their time filling out forms.

According to another study, doctors, nurses, and medical assistants spend at least $31 billion a year dealing with health plans.

But if doctors think that a government takeover of the nation's healthcare system will ease the administrative burdens they face, they need to get a second opinion -- stat.

Take the government's two biggest healthcare programs, Medicare and Medicaid, which are notorious for saddling doctors with paperwork.

The American Hospital Association notes that a Medicare patient who comes to the ER has to fill out eight different forms. Each time a doctor orders a test, Medicare requires documentation to prove it's necessary. Medical records have to be reviewed by at least four people to ensure compliance with Medicare's ever-changing rules. Discharging a patient requires as much as 30 pages of documentation. More than 20 federal agencies are involved in hospital regulations.

As for Medicaid, meanwhile, a study published by Health Affairs concluded that "delays in reimbursement can offset the effects of high Medicaid fees, thereby lowering participation." In other words, doctors would rather not take Medicaid than deal with its administrative burdens.

Or consider the Obama administration's electronic health records mandate, which required healthcare providers to adopt and demonstrate "meaningful use" of such records in order to qualify for full reimbursement from Medicare and Medicaid.

Instead of improving the quality and efficiency of care, the mandate has cost doctors precious time and money. Only 11 percent of doctors told The Physicians Foundation in 2016 that electronic health records has improved patient interactions. Sixty percent said that EHRs had made things worse.

Single-payer's proponents claim that a government takeover of health care will give doctors their autonomy back. They won't have to seek prior authorization from insurance companies to prescribe certain expensive therapies, or adhere to insurer-driven treatment guidelines.

This, too, is a fantasy. Under single-payer, there are only two ways to control costs -- by paying healthcare providers less or by controlling the care patients can get.

The former strategy is alive and well in existing government healthcare programs. The American Hospital Association estimates that Medicare and Medicaid underpaid healthcare providers by nearly $58 billion in 2015. Hospitals received 88 cents for every dollar they spent treating Medicare patients, and 90 cents for each dollar spent treating those on Medicaid.

Doctors only acquiesce to that sort of underpayment now because they can make up the difference by billing private insurers more. Single-payer would eliminate that cash cow.

It's hard to believe that doctors will swallow a significant pay cut in exchange for, well, nothing. But a government takeover of health care would give bureaucrats virtually unlimited ability to dictate prices to doctors. They could either take it -- or find another profession.

Or they could band together under the banner of a labor union, as other public employees have done. That's exactly what some doctors have begun to advocate for.

But how happy will doctors be when their practices end up being run like, say, public schools? Should doctors and patients alike welcome a system where incompetent doctors can't be fired, where outcomes remain stagnant for decades, and where seniority rather than skill determines pay? Will America's best and brightest still consider careers in medicine?

The United Kingdom's best and brightest certainly haven't. The country's National Health Service is suffering from a serious shortage of general practitioners. Almost half say they're planning to quit because of "perilously" low morale. The government is responding not by trying to address their concerns -- but by trying to recruit 2,000 foreign doctors to fill the shortage.

Doctors beware. Single-payer is most definitely hazardous to your health -- and to the health of your patients.